Hypercalcemia - causes, diagnosis and treatment

Hypercalcemia.

Hypercalcemia - This is an increase in serum in the blood of a common calcium concentration of more than 2.8 mmol / l or ionized calcium above 1.3 mmol / l. The cause of this state may be hyperparathyroidism, malignant neoplasm, long-term use of drugs. Symptoms include Insipota syndrome (polyuria, polydipsy), general muscle weakness, neuropsychiatric disorders. To form a diagnosis, the level of ionized calcium (Ca2 +) has a greater importance. For treatment, 0.9% NaCl, loop diuretics, bifosphonates are used.

Calcium is a vital macroelement that performs many functions in the human body (providing muscle contraction, blood coagulation, nervous impulse). Calcium is also the main component of bone tissue. In the regulation of its metabolism, the most important participation is taken by calcitriol (vitamin D), parartgamon. Hypercalcemia is a fairly common electrolyte disorder, it occurs with a frequency of approximately 0.17 to 3.9 cases per 100 people. Gender differences vary in people of different ages. This state is more susceptible to men of young age, women older than 45 years old.

Causes of hypercalcemia

Hypercalcemia almost always testifies to any disease or pathological process. However, sometimes it develops as a result of physiological causes (in newborns on the 4th day of life, in adults after meals). The pathological reasons for this state are as follows:

  • Hyperparathyroidism. This is an endocrine disease characterized by hypersecretion of parathyroid hormone (PTH). It is the most common cause of hypercalcemia. Hyperparathyroidism is due to adenoma, parasite hyperplasia, renal failure. Sometimes hyperparathyroidism occurs within the framework of autoimmune polynonglandular syndrome or multiple endocrine neoplasias.
  • Oncological diseases. The second in frequency is recognized as the cause of this electrolyte violation. When cancer, it arises in two mechanisms. The first is the destruction of the bone with metastases or primary hearth (leukemia, lymphoma, myeloma disease). The second mechanism is the synthesis of cancer cells of the PTH-like peptide (lung cancer, breast, bladder).
  • Granulomatous processes. Chronic diseases characterized by formation in tissues (primarily in the lungs) cell granuloma can also be the cause of hypercalcemia. These include tuberculosis, sarcoidosis, histoplasmosis. Mononuclear phagocytes that are part of the granuloma due to the expression of 1-alpha hydroxylase are capable of converting vitamin D to the active form (calcitriryrol, 1.25oh-d3), which enhances the suction of calcium ions by the small intestine.
  • Long immobilization. As a result of a long lack of motor activity, osteoclasts are activated (cells that destroy bone tissue by dissolving mineral compounds). This leads to the exit of calcium ions from bones. Such a phenomenon occurs during forced immobilization after injuries, finding in conditions of weightlessness (during space flights).
  • Reception of drugs. First of all, this refers to vitamin D, calcium drugs. Other medicines (thiazide diuretics, theophylline, lithium) can also cause calcium imbalance by enhancing osteo-destruction or reabsorption processes in kidney nephron tubes.
  • Other endocrine disorders. In addition to the pathology of the parachitoid glands, other endocrine diseases are sometimes caused by hypercalcemia. For example, an excess of thyroid hormones in hyperthyroidism enhances the destruction of bone tissue. In the adrenal insufficiency, the inhibitory effect of glucocorticoids on calcium metabolism is reduced.

Pathogenesis

An increase in the blood content of calcium changes the membrane potential of cells, which leads to the oppression of neuromuscular conductivity in skeletal muscles, myocardium, gastrointestinal tract. The pathogenesis of psychoneurological symptoms is not completely clear. It is assumed that the role of slowing the nerve impulses. Calcification of vessels, internal organs, dystrophy, fabric wrinkling are developed.

Due to hypercalciuria (increasing calcium filtering in nephron tubules) risk nephrolithiasis. Calcium inhibits adenylate cyclase, which suppresses the renal effect of antidiuretic hormone. Also, due to the high extracellular concentration of this cation, the secretion of hydrochloric acid by planting cells of the stomach is enhanced, which leads to the development of peptic ulcers.

Classification

For flow, chronic and acute hypercalcemia (hypercalcemic crisis) are distinguished. In terms of cation (in mmol / l), the following severity of hypercalcemia distinguishes:

  • Easy. The content of the total Ca is less than 3, ionized - less than 1.5.
  • Moderate. The level of total Ca to 3.5, ionized to 1.8.
  • Heavy. General Ca above 3.5, ionized - more than 1.8.

Separately considered pseudogpercalcemia. Part of calcium binds to plasma proteins, therefore diseases such as paraproteinemic hemoblastosis (multiple myeloma), characterized by a high protein content in the blood, are accompanied by an increase in the level of total calcium. Exclude false hypercalcemia helps the determination of ionized calcium.

Symptoms of hypercalcemia

With a mild pathology, symptoms may generally be absent. With moderate, severe, muscle weakness appear, sometimes reaching such severity that the patient is difficult to climb from bed. Symptoms are characterized by the gastrointestinal tract - nausea, vomiting Abdominal pain. The appetite is significantly reduced, constipation arise. Cardiological symptoms are often observed (enhancement of blood pressure, tachycardia).

Even with hypercalcemia of neonqualic origin, due to anorexia and muscle dystrophy, the patient loses weight, acquires a cached look, which is why there may be a false impression about the presence of a malignant neoplasm. The weakening of the effect of antidiuretic hormone on the kidneys causes the emergence of such symptoms as a strong thirst, an increase in the urination to 5-6 liters per day.

Nervous psychological symptoms are especially bright. First, emotional instability arises, a violation of the concentration of attention, small drowsiness. With severe pathology, the confusion of consciousness, delirium, psychosis develops. Possible hallucinations. With a long-lasting high level of calcium, it begins postponed in the tissues of the joints (chondroalcinosis), which causes arthralgia.

Complications

Hypercalcemia has a wide range of adverse effects. The most frequent complications are osteoporosis (due to the enhanced exit of calcium ion bones), pathological fractures, urolithiasis. Less often arise acute pancreatitis and intestinal obstruction. The most dangerous to life of the state is the hypercalcemic crisis, in which mortality reaches 60%. The cause of death becomes cardiac or renal failure.

Another heavy, but rare complication is considered calcification (calcification of uremic arteriolopathy), characterized by ischemic skin necrosis, subcutaneous fatty fiber. It develops in patients with terminal renal deficiency stages. A long-term increase in calcium in the blood can also lead to belt keratopathy, the calcification of the aorta and heart valves with the formation of the heart rate.

Diagnostics

The profile of a specialist doctor who oversees the patient with this pathology is determined by the reason that caused this state. Most often, such patients are observed in endocrinologists, nephrologists, oncologists. When polling the patient necessarily clarifies which drugs it takes. During inspection, the doctor draws attention to such symptoms as a decrease in muscle tone, inhibition of tendon reflexes. Additional examination is assigned, including:

  • Laboratory research. In biochemical blood test, the level of albumin, urea, creatinine is measured. From electrolytes, in addition to the total and ionized Ca, the concentration of phosphorus, chlorides is determined. The content of vitamin D (25OH-D) is investigated. PTH, PTH-like peptides. The daily excretion of Ca with urine is checked. In suspected thyrotoxicosis or hypocorticism, blood test is carried out on hormones (TTG, free T4, cortisol).
  • Functional samples. Invaluable assistance for differential diagnosis of the causes of this disorder have special provoking tests. These include samples with native vitamin D, tiazide diuretics, calcitonin. Exclude a process that is not associated with the increased secretion of PTH allows the steroid suppression test with prednisone.
  • Instrumental research. To search for adenoma or hyperplasia of the rest of the face, their ultrasound is performed, computed tomography, scintigraphy. In order to determine the mineral density of bone tissue, densitometry is carried out, for the diagnosis of nephrolithiasis - the ultrasound of the kidneys. If there are symptoms that cause suspicion of an inflammatory process in lungs or malignant neoplasm, to identify them should be prescribed x-ray, CT lungs, abdominal organs, mammography.

Differential diagnosis must be carried out by prevailing symptoms. Insipotar syndrome needs to be differentiated with sugar and nonaxing diabetes. Muscular weakness, hypotension should be distinguished from that with muscle dystrophy, myasthenia, polyimosit. Neriva-mental symptoms require elimination of psychiatric diseases.

Scintigraphy. Adenoma of the parachitoid gland

Scintigraphy. Adenoma of the parachitoid gland

Treatment of hypercalcemia

Conservative therapy

Patients with any degree of severity for treatment should be hospitalized to the hospital (endocrinological, nephrological department). Patients with severe neurological symptoms, hypercalcemic crisis should be transferred to the intensive care unit and intensive therapy. It is required to cancel all drugs that can cause an increase in calcium level. The treatment of hypercalcemia has the following directions:

  • Strengthening calcium with urine. First, it is necessary to ensure adequate rehydration with NaCl saline (0.9%). This will improve the kidney perfusion, increase the filtering of calcium ions by kidney glomers. Additionally, forced diuresis with loop diuretics (furosemide) is carried out. It is necessary to continuously monitor the level of blood electrolytes.
  • Reduced suction CA. In the intestines. For this purpose, sodium or potassium phosphate salts are well suited. Phosphates are strictly contraindicated for the treatment of secondary hyperparathyroidism caused by renal failure. Also, glucocorticosteroids (prednisone, hydrocortisone), synthetic antimalarium preparations (hydroxychlorookhin, chlorookhin) are used to suppress the absorption of Ca in the gastrointestinal tract.
  • Suppression of bone resorption. An important stage of treating hypercalcemia, the cause of which has become hyperparathyroidism or oncological disease. The most effective preparations for preventing the progression of osteoporosis are bifosphonates (pamidron, goldcuric acid), which inhibit the activity of osteoclasts. Similar mechanism of action, but a faster effect, a peptide hormone calcitonin has a cytotoxic antibiotic Mitramycin.
  • Suppression of the production of PTH and PTH-like protein. For pathogenetic treatment of primary and secondary hyperparathyroidism, calcamimetics (cynakaltseet) are used, which increase the sensitivity of the receptor cells of the SCC, thereby reducing PTG products. As the treatment of hypercalcemia caused by a malignant tumor, gallium nitrate, inhibiting the secretion by cells of the PTH-like protein tumor cells.
  • Intensive therapy. For the treatment of severe life-threatening states (hypercalcemic crisis, calcification), as well as in the ineffectiveness of other conservative methods of therapy, a meter of emergency decrease in serum in serum is hemodialysis using a low-cylinder dialysis solution.

Surgery

Operational removal of parachitoid glands is the main treatment of primary hyperparathyroidism. The main indication to surgical intervention is the level of Ca above 2.75 mmol / l. For the prevention of postoperative hypocalcemia ("hungry bone syndrome"), Vitamin D, CA preparations are prescribed to the patient. Malignant tumors are also deleted. For the treatment of oncohematological pathologies, bone marrow transplantation is performed.

Experimental treatment

Currently, new medicines are being developed for the treatment of this state. At the stage of clinical trials there is an osteoprotegery drug, which is cytokine from the family of tumor necrosis factors. It slows down the differentiation of osteoclasts, stimulates their apoptosis. In Vitro experiments, the analogue of Calcitrix EB 1089 suppressed the expression of the PTH peptide gene.

Prediction and prevention

Hypercalcemia is severe, and in some cases (especially in acute flow) life-threatening pathological condition. With hypercalcemic crisis, mortality is very high (60%). The frequency of death in the chronic flow on average is 20-25%. However, a more prediction is determined by the reason for increasing the level of CA.

The prevention of this pathology lies in timely diagnosis and proper treatment of diseases, against which it develops. Before the use of vitamin D or other drugs, which can increase the CA content in the blood, it is necessary to test the blood test to assess its concentration.

What does calcium increase in blood

Everyone knows that the lack of nutrients in the body can lead to a decrease in immunity and various diseases. But few people think about the excess of the same elements is no less dangerous for the body.

Content:

Hypercalcemia - what it is

Calcium is an indispensable element that participates in the formation of bone tissue, is responsible for the bone strength and prevents the emergence of seizures in the muscles. His lack becomes the reason for the development of Rahita, leads to the brittleness of bones, fragility of nails and other health problems.

At the same time, excessive calcium content in the blood is no less dangerous. Hypercalcemia is a condition in which the concentration of calcium molecules in the blood exceeds the norm.

Causes of hypercalcemia

Many reasons may cause an increase in blood calcium level. Among them:

  • Improper use of vitamin D - with impairment of recommended doses.
  • Changes in the work of the endocrine system, when parathyroid gland starts working in excessively active mode.
  • The emergence of malignant tumors. This is especially characteristic of breast cancer, lungs and blood.
  • Renal failure.
  • The uncontrolled consumption of products containing high concentrations of calcium, as well as the reception of vitamin kits without the recommendations of the doctor.
  • Tuberculosis.
  • Strong dehydration of the body.

In addition, a sedentary lifestyle caused by the forced immobilization of the limbs, for example, under fractures or paralysis, also causes the high calcium content in the blood.

How hypercalcemia is manifested

Pay attention to your health and find out the level of calcium in the body, if the following symptoms began to appear without visible reasons:

  • rejection of food due to loss of appetite;
  • making defecation, especially on a regular basis;
  • constantly tormenting thirst;
  • lack of force in the limbs, which is explained by the weakness of the muscles;
  • aggravation of anxiety and tendency to depressions;
  • Inexplicable vomiting or constant nausea.

Dehydration, which develops due to a high level of calcium, caused by the increased activity of the kidneys that respond to an excess of this element. In connection with which secondary symptoms can be:

  • feeling of drying in the mouth;
  • Dark color of urine;
  • lack of saliva;
  • Total weakness and drowsiness.

At the first signs of dehydration, you need to immediately cause medical care, as this state can lead to a fatal outcome. Before the arrival of the doctor, the patient is shown to rich with warm drinks.

What complications can lead

When a high level of calcium was found randomly, it is necessary to immediately take measures to avoid complications. Ignoring metabolic disorders can lead to:

  • Osteoparosis. The lack of adequate treatment leads to the fact that calcium is released from the skeleton in the bloodstream. It becomes the main reason for thinning bones and joints, which means that bone fragility increases. In 85% of patients with hypercalcemia, the spinal curvature is observed.
  • The formation of stones in the kidneys. The kidneys - a pair filter organ that cleans blood, and therefore they dig in themselves including calcium. Unfortunately, at an early stage, it is impossible to identify stones. They make themselves knew about themselves when the situation is already launched and the blockage of the ducts or the movement of stones on the ureters, which is always due to unbearable pain begins.
  • Larous and other disorders of the central nervous system.
  • Heart rhythm.

The first, as a rule, suffer the musculoskeletal system and kidneys. With frequent urges to urination, not only the bladder is needed, but also blood for calcium content.

How to diagnose hypercalcemia

If an excess of keratin or violation in the work of the liver can be determined by yellowish skin color, then the excess calcium on the eye cannot be diagnosed. You can find out the level of calcium through an uncomplicated biochemical blood test. If the laboratory will noted an excess element, an additional examination will be appointed, which is already aimed at identifying the cause of metabolic disorders.

Women showing mammography to eliminate breast cancer. At the same time, it is important to pass the radiography of the thoracic. In order to find out how much bones have lost their strength, a magnetic resonant tomogram is shown. It will show the density of the skeleton and will identify particularly exhausted areas.

If the patient takes any medicines on an ongoing basis, it is necessary to inform you to inform your doctor to take into account this when deciphering diagnostic materials.

Treatment of hypercalcemia

In certain cases, drug treatment is not appointed. This concerns the cases when the calcium level does not greatly exceed the permissible limits of the norm. In such a situation, it is enough to discuss the correction of the power mode, including a list of prohibited products, including:

  • milk;
  • cheese;
  • cottage cheese;
  • yogurt;
  • kefir;
  • Nuts.

After a certain period of time, the patient will be assigned a repeated blood test. He will show, normalized her composition or not.

In more severe situations, diuretics can be appointed, provided that the work of the kidneys is not broken, and the body does not threaten dehydration. It is important to strictly observe the dosage, because such drugs lead to a sharp decrease in blood pressure.

If excess calcium is caused by serious health problems, the patient will be hospitalized to provide medical care.

What you need to remember

It is very important to eat diverse and fully. This depends on the composition of the blood, nutrition of the body cells and maintaining the balance of nutrients. Do not need to take preparations, calcium content and other vitamin complexes. Only after laboratory diagnostics can be assigned a course of receiving synthetic vitamins.

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